The quality of evidence is downgraded by study limitations (unclear allocation concealment and failure to adhere to the intention-to-treat principle).
Starting statin therapy preoperatively is recommended for patients referred to coronary artery bypass grafting surgery.
The recommendation is strong because potential benefits of the intervention clearly exceed plausible harms.
A Cochrane review [Abstract] 1 [withdrawn from publication] included 17 studies with a total of 2 138 subjects undergoing cardiac surgical procedures (mainly coronary artery bypass grafting, CABG). Atorvastatin was used in 11 studies, simvastatin in 3 studies, fluvastatin, rosuvastatin, and pravastatin in one study, respectively. A comparison with placebo was carried out in 10 studies, whereas 7 studies compared patients receiving preoperative statin treatment to a statin naive control group without placebo therapy. The duration of preoperative intake of statin varied from the evening before surgery to 4 weeks before the operation.
Statin pre-treatment before surgery reduced the incidence of post-operative atrial fibrillation (AF), but failed to influence short-term mortality, post-operative stroke, myocardial infarction (MI), or renal failure. Statin therapy was associated with a shorter length of stay of patients on the intensive care unit (ICU) and in-hospital; for length of hospital stay, significant heterogeneity was observed among studies. No major or minor perioperative statin side-effects were reported from trials investigating this safety endpoint.
| Outcome | Number of participants (studies) | Mean follow-up | Asssumed risk (control) | Corresponding risk (statin) | Relative effect (95% CI) |
|---|---|---|---|---|---|
| Mortality | 300 (2 studies) | 11 days | 13 per 1000 | 24 per 1000 (5 to 104) | OR 1.80 (0.38 to 8.54) |
| Myocardial infarction | 901 (7 studies) | 19 days | 31 per 1000 | 15 per 1000 (7 to 35) | OR 0.48 (0.21 to 1.13) |
| Atrial fibrillation | 1 765 (12 studies) | 20 days | 322 per 1000 | 204 per 1000 (170 to 242) | OR 0.54 (0.43 to 0.67) |
| Stroke | 264 (2 studies) | 15 days | 23 per 1000 | 16 per 1000 (3 to 78) | OR 0.7 (0.14 to 3.63) |
| Renal failure | 467 (5 studies) | 9 days | 125 per 1000 | 75 per 1000(41 to 136) | OR 0.57 (0.3 to 1.1) |
| Length of stay in hospital | 1 137 (11 studies) | 16 days | Mean length of stay in hospital in the intervention groups was 0.41 days lower (0.73 to 0.08 lower) | ||
| Length of stay on ICU | 721 (9 studies) | 18.5 hours | Mean length of stay on ICU in the intervention groups was2.54 hours lower(4.72 to 0.36 lower) | ||
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